Mechanisms of Listening Effort in School Age Children who are Hard of Hearing

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1 ABSTRACT 2 Many children with mild to severe hearing loss are identified and receive early intervention at very young ages. 3 Even with this early intervention, however, children who are hard of hearing (CHH) experience challenges with 4 communication due to reduced access to the auditory signal. These challenges are further compounded in 5 school because CHH have increased difficulty perceiving speech in adverse acoustic conditions and most 6 listening conditions are characterized by poor acoustics. When listening in adverse conditions, CHH must exert 7 additional cognitive resources compared to children with normal hearing (CNH) in order to perceive an incoming 8 message. Consequently, they have fewer cognitive resources available to perform additional tasks and must 9 expend increased listening effort. Listening effort requires the coordination of low-level, bottom-up processes, 10 and higher-level, top-down processes. There is a lack of evidence regarding the interplay between auditory 11 access and higher-level cognitive skills in influencing individual differences in listening effort for CHH. This 12 knowledge gap hinders the understanding of the underlying mechanisms that drive listening effort in children 13 with hearing loss, which in turn, limits the ability to develop evidence-based interventions for this population. The 14 current proposal seeks to determine the factors that underlie increased listening effort in school-age CHH. This 15 proposal is based on a limited resources capacity theory, which posits that listeners require additional cognitive 16 resources to maintain optimal listening performance during adverse acoustic conditions, and this demand on 17 resources results in a decline in performance on secondary tasks. Specifically, the current proposal tests the 18 hypothesis that top-down processing, quantified by working memory and linguistic skills, is associated with 19 listening effort in school-age CHH, and this relationship is moderated by bottom-up processing, measured via 20 aided audibility. Two specific aims are proposed to test this hypothesis: Aim 1. To determine the effect of higher- 21 level cognitive-linguistic skills on listening effort in school-age children who are hard of hearing, and to evaluate 22 the extent to which auditory access influences the relationship between cognitive-linguistic skills and listening 23 effort. Aim 2. To identify the effects of hearing aid use and background noise on listening effort in children who 24 are hard of hearing. In Aim 1, working memory capacity, receptive vocabulary, and aided speech audibility will 25 be used to predict listening effort in varying levels of background noise. In Aim 2, listening effort for CHH will be 26 evaluated in aided and unaided conditions, in quiet and in background noise. In both aims, different dimensions 27 of listening effort will be captured, including reaction time, self-report measures, and speech recognition 28 performance. The data generated from this proposal will inform theoretical models regarding the integration of 29 low-level, acoustic-phonetic input and higher-level, cognitive-linguistic processes involved in listening, using a 30 mechanistic approach to examine listening effort. The proposed study will also provide empirical evidence for the 31 development of effective interventions for children with hearing loss, in both classroom and social settings.